Provider Demographics
NPI:1720213812
Name:TSYRULNYKOV, EDUARD (APNP)
Entity type:Individual
Prefix:
First Name:EDUARD
Middle Name:
Last Name:TSYRULNYKOV
Suffix:
Gender:M
Credentials:APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4800 N SCOTTSDALE RD STE 2500
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-7630
Mailing Address - Country:US
Mailing Address - Phone:262-999-3495
Mailing Address - Fax:
Practice Address - Street 1:11649 N PORT WASHINGTON RD STE 201&221
Practice Address - Street 2:
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53092-3460
Practice Address - Country:US
Practice Address - Phone:262-999-3495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-19
Last Update Date:2025-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9921-33363LP0808X, 363LP0808X
WI200181163W00000X
FLAPRN11016687363LP0808X
CA95019975363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty